Provider Demographics
NPI:1003896358
Name:LEWIS, ANGELIA DENIESE (ARNP)
Entity Type:Individual
Prefix:
First Name:ANGELIA
Middle Name:DENIESE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2867
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36652-2867
Mailing Address - Country:US
Mailing Address - Phone:251-690-8894
Mailing Address - Fax:251-544-2188
Practice Address - Street 1:251 N BAYOU ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36603
Practice Address - Country:US
Practice Address - Phone:251-690-8894
Practice Address - Fax:251-544-2188
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9232731363L00000X
AL1-073404363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY083XOtherBCBS
AL630000013Medicaid
AL011846OtherMEDICARE GROUP NUMBER
AL1063439065OtherGROUP NPI PAYEE NUMBER
Q57288Medicare UPIN
FLY083XOtherBCBS